MINISTER OF HEALTH OPENING STATEMENT PRESS BRIEFING

29/01/2020
VENUE: NATIONAL INSTITUTE OF COMMUNICABLE

The Department of Health wishes to assure the public that South Africa is
adequately prepared for active surveillance, early detection, isolation and
case management, contact tracing and prevention of onward spread of
Coronavirus infection, and to share full data with the World Health Or-
ganisation (WHO). South Africa has no reported or suspected cases to
date.

Research into the epidemiology and natural history of the virus is ongoing.
Although the origin of the disease in Wuhan City, China, is suspected to
be zoonotic (that is animal origin), evidence suggests that current spread is
from human to human. According to the WHO the incubation period is
about 2-10 days though some literature has cited up to 14 days. More evi-
dence is needed to determine if asymptomatic patients are contagious, alt-
hough the preliminary evidence suggests that, like SARS and Ebola, all the
contacts reported were patients who had symptoms. Typically, patients
present with flu like symptoms and cough. The disease can be complicated
by shortness of breath, multi-organ failure and death. Most fatalities re-
ported were elderly people or persons with pre-existing co-morbidities,
suggesting that these are the population groups that are most at risk. Con-
trary to some media reports there is no evidence that the genotype of the
organism is mutating- the virus still looks the same now as the first one
isolated in December.

The Department is aware of the cases that have emerged in countries out-
side of China and is closely tracking the movements of the virus. The
numbers change rapidly and so I may quote something now only to find
that the numbers have changed as we speak. Closer to our shores we are
aware that there is a suspected case under investigation in Zambia- the
NICD is closely monitoring that situation. We will shortly invite Professor
Cheryl Cohen from this institute to elaborate in more detail how the insti-
tute is tracking the numbers and how it keeps the public and stakeholders
informed. You will also have an opportunity to walk through the Emer-
gency Operating Centre straight after this briefing where you will be able
to see for yourselves the hard work and expertise that goes into responding
to a disease outbreak that could be potentially pandemic.

On 27 January we published travel advise based on the WHO recommen-

dations: these take into consideration all factors which determine the level
of threat to a particular territory. The guidelines have not recommended
any restriction on travel and trade but it is recommended that non- essen-
tial travel to Wuhan City or Hubei Province should be avoided or post-
poned. Prospective travelers can monitor the situation and plan their travel
accordingly. Our understanding is that, currently, Wuhan City is essen-
tially quarantined and 5 million citizens have been evacuated. Chinese au-
thorities have closed all public transport entering and leaving Wuhan and
other areas in Hubei province.

South Africa has responded rapidly to ensure that the Coronavirus does not
become a national threat. As a department it is standard procedure to mon-
itor emergent outbreaks and we are currently tracking a plethora of patho-
gens including those viruses of pandemic potential like H5N1- we wish to
reassure that Coronavirus is no exception. In the recent past we have effec-
tively responded to public health issues such as the Ebola virus outbreak
that is currently ongoing in the Democratic Republic of Congo.

In regard to Coronavirus, due to the rapidly evolving situation in China, The

Multi-sectoral National Outbreak Response Team (MNORT) was recon-
vened on 24 January 2020. MNORT comprises the WHO; National Depart-
ments such as Home Affairs, Agriculture, International Relations, Tourism;
and representatives of Private Health Sector. At the meeting an Incidence
Management System (IMS) was set up, with the key roles and responsibili-
ties identified and named responsible officials attached to each key func-
tional area

The current activities already undertaken by the NDOH and NICD in-
clude:

• An alert that was developed and disseminated to all provinces and stake-
holders;

• MNORT and Provincial outbreak response teams have been activated

• Press releases have been circulated and various officials from departments
of Health and International Relations have been interacting with the media
and the public. Our media analytics have revealed 284 media citations of
Coronavirus with an estimated reach of over 125 million people between 20
and 26 January 2020

• A hotline has been set up at the NICD to field questions from clinicians

• South Africa has developed and distributed clinical guidelines and case
definitions to doctors and nurses in both the public and the private sectors,
which include information on how to diagnose and respond to a possible
2019-nCoV case.

• Provinces have activated outbreak response teams and are on high alert to
detect and manage inadvertent cases that may arrive in the country.

• Screening of returning travelers from China at major airports has been in-
tensified- I will go into detail in this regard as this is of course of paramount
concern:

Our Port Health Officials routinely conduct temperature screening for all
international travellers. However, due to the current risk of importation of
inadvertent cases of 2019-nCoV from Wuhan City in China, our Port Health
authorities have intensified surveillance of all travelers from Asia, espe-
cially China.

Port Health Service is responsible for preventing, protecting and providing

a public health response to the international spread of diseases through the
Points of Entry (PoE).

Port Health Services are provided in 36 Points of Entry with a staff compli-
ment of 300 personnel .

The service is provided on an adhoc basis in the remaining smaller PoE.

Screening is conducted in the PoE to early detect an ill traveller by the fol-
lowing means:
 1. Temperature screening is conducted in 12 PoE utilising non-inva-
sive thermometers where all travellers arriving through these PoE
are channelled to the temperature screening. If a traveller is found
to have an elevated temperature, they are assessed by a Nurse and
if determined to be a suspect case they are transported to a health
facility for further management. The NICD is immediately notified

2. Arriving conveyances (transport vehicle) - Health officials go on

board each arriving international aircraft and ship to determine if
there is any sick traveller. If a traveller falls ill whilst on board,
port health officials are informed by the crew members in line with
World Health Organization (WHO) and International Civil Avia-
tion Organization (ICAO) requirements and an assessment of the
traveller is conducted upon arrival. If the traveller is found to ex-
hibit symptoms consistent with novel coronavirus, the traveller
would be transported to a medical facility for further management.
Contact information of travelers who may have been in contact
with the ill travellers are collected and used to follow up if neces-
sary.

3. As the busiest airport in Africa, special measures have been intro-

duced in OR Tambo International Airport where travelers on direct
aircraft from China in the past 14 days are required to complete a
questionnaire for possible contact tracing.

The National Institute of Communicable Disease (NICD) remains vigilant

in monitoring the movement of this virus as reported by World Health Or-
ganisation and the team will take you through their Emergency Operations
Centre to show you how they do this.

We are working closely with the international community and particularly

with Chinese Officials through the WHO

An Emergency Committee meeting was convened on Wednesday, 22 Jan-

uary 2020 by the WHO Director-General under the International Health
Regulations (IHR)(2005). They concluded that although developments in
China were concerning, it is still too early to declare a PHEIC- Public
Health Emergency of International Concern. There is wide consensus in-
ternationally that there is no cause for panic, with experts pointing out that
the common flu still remains an important disease burden: WHO estimates
that seasonal influenza may result in 290 000-650 000 deaths each year
due to respiratory diseases alone. This perspective is important to maintain
lest we get distracted and lose sight of ongoing priorities.

We have received a number of queries regarding the safety and health se-
curity of our citizens living in China, particularly those in Wuhan City or
Hubei Province. A meeting was convened by the Chinese Foreign Ministry
with diplomatic missions on 27 January 2020. In summary the government
of the People’s Republic of China has reassured us that there is no evi-
dence to support the necessity to evacuate foreign nationals living in Wu-
han City and they have called for calm in this respect. All persons entering
or leaving Wuhan are subjected to a 14 day quarantine to ensure they do
not develop symptoms. Foreign nationals who need medical assistance for
whatever reason will be treated like Chinese citizens and be afforded all
the medical care necessary. Embassies are enabled to support those locked
out and locked inside Wuhan.

I have asked the Ministry of International Relations to be here with us to-

day so they can share the developments at DIRCO in responding to the
outbreak. DIRCO has been closely collaborating with all relevant stake-
holders to respond appropriately to the needs of our citizens who either
may want to go to, exit or remain in China. It is important to understand
that how we respond as a country must represent the best interest of the
people whom we intend to aid.

In conclusion, I wish to reiterate the basic principles to reduce the general

risk of transmission of acute respiratory infections, which include the fol-
lowing:

‒ Avoiding close contact with people suffering from acute respiratory

infections.
‒ Frequent hand-washing, especially after direct contact with ill people
or their environment.
‒ Avoiding unprotected contact with farm or wild animals if traveling in
China
 ‒ When sneezing or coughing it is better to cover your nose and mouth
with a tissue or arm and not your hands

In case of symptoms suggestive of respiratory illness before, during or after

travel, the traveller must seek medical attention and share travel history with
their health care provider.

For more information on 2019-nCoV or other diseases, please visit

http://www.nicd.ac.za/diseases-a-z-index/

For Medical/clinical related queries: Contact the NICD Hotline +27 82

883 9920

Guidelines and other useful resources are available on the NICD website:
www.nicd.ac.za

The Department of Health will issue daily updates by voice notes and
through radio stations to keep the public informed and abreast of develop-
ments until the situation abates.